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How to Lose a Drug War: Heroin, HIV, and the Russian Federation

The fall of the Soviet Union brought many benefits to Russian society, but the surge in heroin trafficking wasn't one of them. By the middle of the 1990s, an epidemic of intravenous heroin abuse had spread from the Kazakhstan border to St. Petersburg.

The risks to heroin users were well known to world's public health community by then: a crippling opiate dependency, death by overdose or poisoning, and, most significantly, the transmission of HIV.

The response of the Russian government to the new HIV/AIDS threat was not unlike that of the United States to the same threat during the Reagan administration. It was ignored.

Today there are roughly 1.2 million HIV-positive people in Russia and between two and three million people who inject drugs. There are 100,000 new cases of HIV per year. Five percent of the young adult population is infected. The two epidemics reinforce and fuel each other.

The experience of other nations would suggest a number of harm reduction interventions aimed at heroin users would be the most efficient use of resources: the increased availability of clean needle exchanges and opiate substitution drugs such as methadone or buprenorphine being chief among them.

Yet needle exchanges remain rare and opiate substitution drugs have been all but banned.

People with AIDS and HIV and heroin users, the very citizens who ought to be encouraged to seek some sort of help, are a ridiculed and humiliated underclass. Heroin users face harsh criminal penalties, a fact that drives them further underground.

This project aims to give voice to that underclass. It explains why Russia got into this situation, and how a dedicated cadre of local activists and officials are helping things finally change for the better.